Acute Torticollis After Isolated Stress Fracture of the First Rib in a Child

Nontraumatic First Rib Fractures Secondary to Opposing Muscle Contractions

“…These fractures can also present as cases of sudden, acute pain with no prior symptoms as seen in case 2. This sudden muscle contraction mechanism involves pulling from a posterolaterally extended neck with traction on the contralateral arm [1] as described in the original surfer's layback position case [12], and in the two current cases of the basketball player stretching to crack her neck and the cheerleader lifting another cheerleader.…”

“…Instances of non-traumatic first rib fractures have been reported in athletes participating in swimming [1,2], baseball [3,4], football [5,6], soccer [3], tennis [6], powerlifting [7], rowing [8], lacrosse [9], martial arts [10,11], basketball [10], and surfing [12]. Many of these athletes participated in weight training for their respective sport [1,2,7].…”

“…The scalene muscles pull superiorly and the serratus anterior and intercostals pull inferiorly on the first rib at these subclavian grooves [1,4,9,10,11]. Figure 3 Originally labeled Surfer's Rib in 1985, in the absence of direct sudden trauma, the first rib tends to fracture at the subclavian grooves, the weakest point, when these opposing muscles are both suddenly and forcefully engaged [12].…”

First Rib Fractures in Abused Infants

“…An 8-year-old child heard a "pop" and felt a sharp pain in his neck while sitting in class. 12 He subsequently presented with torticollis and a first rib fracture. An 11-year-old girl reportedly had serial fractures of left acromion, clavicle, and lateral first rib attributed to a nervous tic.…”